The Daily - 'It's Like a War.' Revisiting Dr. Fabiano Di Marco.

Episode Date: July 14, 2020

For the remainder of this week, “The Daily” is revisiting episodes with people we met in the early weeks of the coronavirus pandemic to hear what has happened to them since our original conversations were first aired.Italy was an early epicenter of the pandemic in Europe. In March, we spoke to a doctor who was triaging patients north of Milan about the road that might lie ahead for the United States. Today, we call him again to hear what it was like to discharge his last coronavirus patient while the American caseload soars. Guest: Dr. Fabiano Di Marco, a professor at the University of Milan and the head of the respiratory unit of the Hospital Papa Giovanni XXIII in Bergamo. For more information on today’s episode, visit nytimes.com/thedaily Background reading: Italy was one of the first countries in Europe to institute a nationwide lockdown and, later, to choose a cautious approach to reopening public spaces. Here is a comparison of how successful other countries have been in their subsequent responses to the pandemic.

Hey, it's Michael. For the rest of the week, we're revisiting people we met in the early weeks of the pandemic, listening back, and hearing what's happened to them since our original conversations first ran. Today, Dr. Fabiano DiMarco of Bergamo, Italy. It's Tuesday, July 14th. Can you see me? No, I think. I cannot see you, but I can hear you, and I think I can hear you.

Ah, now I can see you. Okay. Sorry for my English. I don't know if my English will be adequate for a podcast, but then you will decide, okay? It's exceptional. And I'm really grateful that you're making time for us. Thank you, thank you.

So where are you right now? Now I'm at home. After three weeks, today in the afternoon, I am at home because I have a big family with three children, and I decided to come back at home one day. So you have not been family with three children, and I decided to come back home one day. So you have not been home in three weeks? Three weeks, yes.

I've been in my hospital every day since the start of the crisis. Friday, the 21st of February, and since then it was a total mess. It's like a war. From The New York Times, I'm Michael Barbaro. This is The Daily. This is how Italy's cases have grown over the last month. Slowly at first, but now more rapidly. It's a textbook epidemic curve.

Italy has quickly become the new epicenter of the pandemic, with nearly 30,000 infections and more than 2,000 deaths, numbers that are soaring by the day, even after the government there took extreme measures to lock down much of the country. We are at a critical inflection point in this country. On Monday, the U.S. Surgeon General warned that the United States is now on a strikingly similar path. People, we are where Italy was two weeks ago in terms of our numbers. And we have a choice to make as a nation. Do we want to go the direction of South Korea and really be aggressive and lower our mortality rates?

Or do we want to go the direction of Italy? Today, a conversation with a doctor in Bergamo, north of Milan, one of Italy's hardest hit areas. It's Tuesday, March 17th. Could I just ask you to just say your full name for me? Okay. My name is Fabiano Di Marco. I'm a professor of the University of Milan and the head of the respiratory unit of the hospital Papa Giovanni XXIII of Bergamo,

which is a town close to Milan. Can you give me a sense and maybe paint the picture of what it's like in the hospital right now, what you're dealing with? I have now, my world has been totally transformed. Nothing is as before. I've been in my hospital every single day and 14 hours or 15 hours a day.

Wow. To try to deal with the outbreak of coronavirus infection. What has been the story of what has happened in your hospital these past few weeks? Because I think people in the United States are desperate to understand what you have seen and what people have said to you and what it has looked like. You described it as a war. So we want to understand what you mean. Okay. Every day we receive on average between 50 to 70 patients with severe respiratory failure due to coronavirus infection every single day. And to describe my reality, my hospital is, at least in Europe, a huge hospital with 1,000 beds.

But to receive every day between 50 and 70 patients with severe pneumonia due to coronavirus, it's impossible. You have to change your organization day by day. And tell me what you mean. How do you have to change your organization to deal with people who are in such severe respiratory condition? So we changed the normal ward, mainly surgery wards, because the activity of surgery has been reduced of at least 80%. And we transformed so far five wards of surgery for patients with coronavirus. Now we have, between the five wards and the emergency room, at least 350 patients with respiratory failure due to coronavirus infection. Today is the first day in which we have more than 50% of the hospital dedicated to coronavirus patients. To organize this, we had to teach cardiologists, dermatologists, rheumatologists, specialists of something very different from respiratory failure, how to treat this patient. You try to find a solution,

but day by day, it's no longer enough. So I can tell you that my colleagues, both physicians and nurses, they cry every day. Wow. I'm 47. I'm not so, so old to be the head of a ward at least in Italy but I have with me 20 colleagues who are respiratory physicians with many fellows they are 27 30 so for me is a huge responsibility and I was scared they can be sick, okay? But we cry every day.

And now we have today 460 nurses at home because they are sick. And I think we have, yes, it's a very huge number. You have 460 nurses who are in a hospital in the middle of this crisis who are home because they're sick. Yeah, today. This in the middle of this crisis, who are home because they're sick? Yeah, today. This is the outcome of today. And is that because they are sick with the coronavirus? There are some who are sick, some with a total burnout for the situation,

and others who are contact of patients, so they stay in quarantine at home. Doctor, you said you are upset that you maybe even cry every day. And I wonder if there is an experience, maybe one story or one patient that made you upset. The main problem for us is to treat our colleagues. As doctor, we are used to treat patients, and for us it's normal. There is not so emotional, luckily,

because we are used to treat other people. But this is difficult when the patient is your colleague. And we have now admitted tens of colleagues or nurse people who you will meet every day in your life. Your colleagues are now your patients because they have contracted the virus. Absolutely. For example, yesterday, the chief of my department come to the emergency room to be with a low level of oxygenation.

He has a bilateral pneumonia due to coronavirus. Wow, I'm sorry. Not very severe, but he was the one who tried to organize the hospital to deal with this infection three days ago. And we went to have a dinner with my wife and his wife one week ago. Wow. I don't know. We are scared because on Friday, only in my hospital, we had 20 deaths.

20 deaths. Yeah. For coronavirus. In one day. That's extraordinary. Yeah. So another important thing, we have not the opportunity to allow the relative to come to the hospital for two reasons. First, it's a danger for them and for other people, evidently, because in 80% of the cases, they are infected.

The second reason, which is not easy to understand if you are not in this situation, is that we do not have enough personal protective equipment. The mask in case of infection, something to cover the shoes, and the gown. It's impossible to find these now in Europe, not only in Italy. So you're running out of those, and you can't get them anywhere in the region or anywhere in Europe. You just can't get them. Yeah, impossible to find. Wow. If I allow one or two relatives to come to the hospital, I have to give them these,

but we do not have this for us. Right. You need them for doctors. Yeah. They cannot receive the relative in hospital. So the patients are alone and they die alone. This is difficult for us. We try to call every day the relative, but I have to tell you that sometimes in the confusion of this new organization with dermatologists who is trying to treat a patient with severe respiratory failure and probably the doctors cry and no one remember to call the relative. So it's happened that the relative called the hospital. And the person's already dead.

Yeah. We'll be right back. Dr. You've mentioned a lot of choices that you and your staff have to make now that this is such a terrible situation. And I wonder how you make decisions about who gets which treatment and who has the best chance to survive. How do you make those decisions? This is, for us, a crucial point because we have hundreds of very sick patients, but we have tens of ICU beds. Right. The problem is that you can find many scores of gravity, but these scores of gravity have been thought for another reason. And when you say score of gravity, you mean basically kind of a calculation of who is in greatest need. Absolutely. So, for instance, if you are 80, you have a severe respiratory failure.

And I don't know, you have also renal failure. I have to admit you in the ICU because you are very severe and you have a probability to die very high. Okay, I have to admit you in the ICU because you are very severe and you have a probability to die very high. Okay, I have to admit you in the ICU. But now we need another score, which is a score which helps us to understand your probability to benefit of the ICU bed. And we do not have this score. Because it has not been created. Absolutely.

We are trying to do this now because, for example, the age, for all this stage of severity, higher is the age, higher is the score. But when you have a few beds for many people, the age is absolutely the opposite. If you are 85, I give the bed to another one who is 45. Because 45-year-old is more likely to benefit from the ICU bed than the 80-year-old.

So you're saying all the normal rules have to be thrown out the window. Absolutely. We need a new tool. We do not have, because so far, the difference between the number of patients, number of beds is something totally new for us. Okay? And not only for us. And not only for us, all the country will have to deal with this.

But it's difficult to tell people that if you are 80, you will never have the ICU bed. Of course. But so far, if you have not the opportunity to build a new hospital with 1,000 beds,

such as in China, we need this terrible tool because this is a tool of selection. Right. Of who lives and who dies. Yeah. And this is why it's important. If you do not reduce the number of patients who are sick, it's impossible to deal with this disease.

Impossible. You have to reduce the rate of infection. And the only way to reduce the rate of infection is to change totally the life of people. Now, in Italy, everyone is at home. This is a tragedy for economy. No one is working. No one is working. But it's the only way. There is not something in between. Sounds like you're saying that once you are in a hospital as a doctor looking at a room full of people with this virus overwhelmed, it's too late.

as a doctor looking at a room full of people with this virus overwhelmed, it's too late. That the role of countries who are not yet at the place Italy is in is to make sure they don't ever get to that place, don't ever get to the point that your hospital is at, and to do whatever it takes to not get there. Absolutely. You have two choices. You decide to not close all the activities, close the people in their home, and you will accept thousands of that. Or you have to close all the activities. There is not a choice in between. I know this is difficult to have this approach because also in Italy, if you speak with my colleague in another town, it's quite difficult to understand this because many people, including many physicians,

have not the perception of this. Because in your reality, all is normal. It's difficult to be scared for something you have not the perception, okay? So I can understand that in other countries it's the same, but trust us. Or, such as in Bergamo, each family will have a relative or a friend who dies. This is the situation in Bergamo. This is not a disease you can discuss on TV.

You will have the perception of this in your family, in your relative, in your town. It's something very aggressive, very aggressive. I wonder, as a doctor, what advice you would give to doctors in the United States who may have to do what you have to do and make the kind of difficult decisions that you have to make now? I think that the best is to speak with us, to analyze the situation of Italy could be something important because you have to be prepared for this.

This is the only thing I would suggest to my colleagues because also in Italy, I have some colleagues in the other part of Italy who are not prepared. And I speak with them. They are doing the same thing we did three weeks ago this is incredible this new reality we are living started the 23rd of february not three years ago okay three weeks ago after three weeks we are living in another dimension.

For me, it's difficult to think to my life before this. No one can be prepared for this. Impossible. I wonder, just a final question here. At the beginning of our conversation, you said you were finally home after three weeks. And I wonder what it was like to come home to your family. What are you telling them and how are you feeling? My children are at home now for three weeks. The schools are closed. Luckily, there are three, so so they they can stay together but we try to create a normal situation at home and for for me it's difficult because evidently i have a risk of infection which is higher than compared to other people so i had to decide what to do at home if stay with a mask. Sorry. I decide to stay normal without the mask.

Sounds like this was a tough decision. Yeah, because I have to find a solution between to protect the best my wife and do not scare my children. Okay? The only good news is that children and young boys or girls are not affected. This is the only

consolation for us. And I decided that I changed my approach to my children okay i pay attention to my hands i pay attention to my towel okay but i decided do not wear a mask because it will be difficult for them to see the father who is a respiratory physician in Bergamo with a dozen of cases, hundreds of deaths. So also for this, it's really difficult to decide what is the best. And I spoke with my wife and we decided to do this.

It sounds like on top of all the difficult decisions you've had to make, you had to go home and make one more difficult decision, which was this mask. Yeah, absolutely. Doctor, I really want to thank you so much for giving us your time and I want to wish you the best of luck. You and all your colleagues, doctors and nurses at the hospital. We're going to be thinking about you a lot in the coming days. Thank you.

Thank you. It has been a privilege. I hope indeed to be useful for some of my colleagues and for you. The crisis in Bergamo has begun to subside. Last week, Dr. DeMarco's hospital discharged its last ICU patient with severe symptoms of COVID-19. It was the first time that the unit had no cases in 137 days. The staff there marked the milestone by observing a moment of silence for the hundreds of patients who have died from the virus, followed by a round of applause for those who had recovered from it. Dr. DeMarco says he's encouraged by the region's progress, but on guard for a second wave of infections.

A few weeks ago, in recognition of his work, Italy's president awarded Dr. DeMarco the prestigious title of Cavaliere, making him a Knight of the Italian Republic. We'll be right back. Here's what else you need to nerdy. I'll remind you, a week or so ago, I was reporting just six lives lost, and then a few days later, well, in excess of 100 lives lost. And so this continues to be a deadly disease. On Monday, as infections soar, California announced a sweeping rollback of its

plans to reopen, saying it would close indoor operations for restaurants, wineries, movie theaters, and zoos, and shut down bars entirely. One thing I just think is incredibly important to remind all of you is that this virus is not going away anytime soon. At the same time, two of the state's largest public school districts, Los Angeles and San Diego, said they would abandon plans to reopen in-person classes in the fall. in the fall. And a new study has found that an estimated 5.4 million Americans lost their health insurance between February and May because of layoffs during the pandemic, a record figure. Nearly half of the insurance losses occurred in just five states, Texas, Florida, New York, North Carolina, and California. That's it for The Daily. I'm Michael Barbaro. See you tomorrow.